Application Form (Au Pair / Mother's Help)

Name:

Surname:

E-mail:

Telephone:

Skype ID:

Date of birth:

Citizenship:

Religion:

Mother's occupation:

Father's occupation:

Age of siblings:

Are you: Single Married Divorced

Qualification:

A-level (High school/ Secondary school)
Bachelor degree
Master (University) degree
Other

Field of studies:

Driver's license: Yes No

When did you receive your driver's license: (date)

How often do you drive?

daily
weekly
monthly
occasionally

Type of roads:

city
town
village
highways

Have you ever had a car accident? Yes No

If yes, please write details:

Are you happy to drive abroad? Yes No Maybe

Sports
Arts
Animals/Pets
Swimming
Travelling
Music
Cinema

History
Photography
Reading
Computers
Cooking
Baking
Other

Can you swim? Yes No

Are you in good health? Yes No

Do you have allergies? Yes No

If yes, please give details:

Do you smoke? Yes No Social (occasional) smoker Not in the house

Have you ever been convicted of any criminal offence? Yes No

If yes, please give details:

Which month can you start?

Earliest possible start date:

Preferred lenght of stay:

Can you stay longer if happy in your host family?

Preferred position:

Au Pair
Au Pair plus
Mini Mother's Help
Mother's Help

Preferred location:

capital
city
town
village
don't mind

Experience 1

Number of children, Age and Gender:

Activities/Duties:

Dates:

How often:

Experience 2

Number of children, Age and Gender:

Activities/Duties:

Dates:

How often:

Experience 3

Number of children, Age and Gender:

Activities/Duties:

Dates:

How often:

Experience 4

Number of children, Age and Gender:

Activities/Duties:

Dates:

How often:

Reference 1

Name:

Tel.:

Speaking English? Yes No

Reference 2

Name:

Tel.:

Speaking English? Yes No

Reference 3

Name:

Tel.:

Speaking English? Yes No

Motivation letter:
(Please detail as much as possible your motivation to be an au pair, write something more about you, your family, and your plans for future. You can also email the Letter to your agency.)
Please see the example of motivation letter